How would Adacolumn® complement the effect of other drugs in the IBD treatment when used in combination?

Dr. Eugeni Domènech

“GMA has been used in several ways as a combination therapy in ulcerative colitis. In fact, the initial use of GMA in Spain was together with conventional course of steroids because the main indication of GMA at the time was steroid dependent ulcerative colitis. More recently, there is some evidence of using a combination of GMA with several biological therapies, mainly Anti-TNF, but is also some evidence of using GMA together with Vedolizumab or Ustekinumab. In this sense, GMA can be added to biological therapies for several reasons. The first one is when we suspect that the patient has a very refractory disease we can use together just looking for synergistic effects among GMA and biological therapies but we can also add on GMA to biological therapies in case of partial responses or in case of secondary loss of response.” Dr. Eugeni Domènech.

Dr. Pilar Nós

“Granulocyte-monocyte apheresis’ mechanism of action is not pharmacological, so it is logical assume that it can have a synergistic effect with any drug. In fact, as it is not pharmacological, it is marketed as a medical device, not a medicinal product. And that’s because what happens is that the acetate beads interact, capturing proinflammatory cells in the bloodstream. So, in situations where, for example, there is a high inflammatory load, you think about using it in combination. In these situations, you can use it together with an anti-TNF that blocks a specific proinflammatory cytokine, so the mechanisms of action are different and they can be synergistic. Or you can use it, for example, with an anti-integrin, which prevents the release…or rather, it stops an inflammatory focus in the colon, the small intestine in the case of Crohn’s disease, from continuing to release substances that attract more proinflammatory factors to the site. The mechanism of action doesn’t have anything to do with the trapping of cells in peripheral blood, rather it’s complementary. Therefore, one of the combinations that has been suggested lately is a combination that combines granulocyte-monocyte apheresis with the inhibition of endothelial adhesion to anti-integrins. It is also true that with other drugs, such as steroids or immunosuppressants, the mechanism of action can also be complementary and synergistic, because what apheresis does is relieve inflammation, in other words, remove the inflammatory load by trapping monocytes and activated leukocytes so that the other drugs have more scope for their mechanism of action.” Dr. Pilar Nós.